10 coding auditor specialist jobs found

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

DRG Coding Auditor Principal _Virtual: _ _ _ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group...

Job Title: Medical Coding Specialist (Outpatient) Location: Falls Church, VA (Hybrid-3 days onsite) Duration: Long Term We are seeking a certified and experienced Medical Coding Specialist (Outpatient) to support Client - Patient Administration Division (PAD) initiatives. The ideal candidate will have strong expertise in outpatient coding, auditing, and compliance within Military Health System (MHS) and MHS GENESIS environments , ensuring accurate and timely coding aligned with high standards. Responsibilities: Perform accurate Outpatient Medical Coding using ICD-10-CM, CPT, and HCPCS in compliance with Client guidelines Conduct Coding Audits and Quality Reviews to ensure accuracy, completeness, and regulatory compliance Review and analyze clinical documentation to assign appropriate diagnosis and procedure codes Work within MHS (Military Health Systems) and MHS GENESIS to support coding workflows and data integrity Ensure compliance with Client...

Summary This position is located in the Health Information Management (HIM) Section at the Central Virginia VA Medical Center. MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. These coding practitioners analyze and abstract patients' health records and assign alpha-numeric codes for each diagnosis and procedure. Duties Help Basic Functions: Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection. Reviews assigned codes from the current version of several coding systems to include current versions of the International Classification of Diseases (ICD),...

Under the direction of the Enterprise Coding Manager, the Enterprise Coding Supervisor is responsible for providing first-line supervision for Medical Coding staff. Supervisor responsibilities include but are not limited to: daily supervision and monitoring of quality and productivity performance, interviewing, hiring, and any necessary discipline of staff. This position also involves participation in process improvement projects and supporting the work needed to meet department and institutional wide goals. Provides daily supervision of coding staff and provides feedback to the Coding Manager on exceptional and/or substandard performance. Leads all efforts associated with hiring, interviewing, onboarding and discipline Provides ongoing feedback to staff on areas for improvement Ensures that all members of the coding team are following official policies and standard procedures and conducts discipline for those in violation Counsels coding staff on actions...

Description The Medical Coder III position plays a critical role in ensuring accurate medical coding and documentation. This involves handling complex case scenarios, applying a combination of facility coding and professional coding, and aligning with industry standards like ICD-10-CM, CPT, and HCPCS codes. The coders will code inpatient facility and inpatient professional rounds and facilitate proper documentation and communication with medical staff to enhance compliance and coding accuracy. Accurately assigns Evaluation and Management (E&M) codes, International Classification of Diseases, Clinical Modification (ICD-CM) diagnoses, ICD-10 Procedure Coding System (ICD-10-PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities derived from medical record documentation (paper or electronic) for the professional and institutional (facility) components of inpatient facility discharges (stays); inpatient...

Responsibilities ***Our Business Department is currently welcoming a full time Certified Medical Coder Specialist!*** **This position is fully in-person and not remote** Key Responsibilities: Assemble and analyzes all discharged records and maintains an organized system for notification of deficiencies. Responsible for sending reports to referral sources and healthcare providers as identified. Assigns appropriate medical codes to charts to assure accurate billing. Assists with data collection and presentation for facility PI activities. Responsible for release of medical record information from active and discharge files in accordance with all applicable legal, accrediting and regulatory agency requirements. Files all loose reports into discharged records. Maintains "copy" file and outside information file. Maintains permanent file and incomplete chart file. Coordinates the transcription of dictated or written materials for medical record reports. The...

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Medical Coder Supervisor to join our growing team. Job Summary: Acentra Health is seeking an experienced Medical Coding Supervisor to lead and oversee medical coding operations in support of...

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

About the Role Loyal Source is looking for a Hybrid Inpatient Coder for employment opportunities at the Naval Medical Center in Portsmouth, Virginia. The Hybrid Inpatient Coder position plays a critical role in ensuring accurate medical coding and documentation. This involves handling complex case scenarios, applying a combination of facility coding and professional coding, and aligning with industry standards like ICD-10-CM, CPT, and HCPCS codes. The coders will code inpatient facility and inpatient professional rounds and facilitate proper documentation and communication with medical staff to enhance compliance and coding accuracy. Key Responsibilities Accurately assign various medical codes and modifiers for inpatient discharges and surgical procedures. Review and resolve inconsistencies in medical documentation. Educate and provide feedback to providers regarding documentation support. Collaborate with medical coding auditors and provide coding guidance to staff. Utilize...